Tuberous sclerosis TRIAD

Characteristic triad of tuberous sclerosis..
3 S


S - SEIZURES

S - SUBNORMAL
INTELLIGENCE

S- SEBACEUM adenoma

apart from this triad it is associated with another S..!

Its SHAGREEN PATCH!!

Chloroquine: uses

" My RED LIP "

• Malaria
• Rhematoiid arthritis
• Extraintestinal amoebiasis
• DLE
• Lepra reaction
• Infectious mononucleosis
• Photogenic reactions

Clinical manifestations of carcinoma stomach

STOMACH

Silent (No symptoms)
Tumor (Lump)
Obstruction
Melena
Achlorhydria, Anemia, Asthenia
Cachexia
Hemetemesis

Ulcerative colitis: definition of a severe attack

A STATE:
Anemia less than 10g/dl
Stool frequency greater than 6 stools/day with blood
Temperature greater than 37.5
Albumin less than 30g/L
Tachycardia greater than 90bpm
ESR greater than 30mm/hr

Diabetic ketoacidosis: I vs. II

ketONE bodies are seen in type ONE diabetes.

MHC I and MHC II: T cell type

'MHC x T cell=8'

• MHC II goes with CD4  (2x4=8)
• MHC I goes with CD8   (1x8=8)

Confusing similar blood cell appearance

SAIL and BERU-

S-Schistocyte also known as
A-Acanthocyte
I-Irregular spikes on surface
L-liver disease

B-Burr cells also known as
E-Echinocyte
R-Regular spikes
U-Uremia

Local signs of a traumatic spleen

"DOKS"

• Debelt's sign
• O'Connel's sign
• Kehr's sign
• Saegesser's sign

Or, "SKODa"

O'Connel's sign: It is Kehr's sign elicited with patient in Trendelenburg position. As it is usually becomes positive before the Kehr's sign, it is at times recommended to elicit O'Connel's sign as well.

Kehr's sign: Pain in the left shoulder caused by irritation of the undersurface of the diaphragm by blood leaking from a ruptured spleen. The pain impulses are referred along the phrenic nerve.

Saegesser's sign: Compression of phrenic point (along the border of the sternocleidomastoid muscle, 2-4 cm above the clavicle) causes sudden contraction of homolateral hemidiaphragm and severe pain along the lateral border of rectus abdominis muscle. It indicates a rupture or intracapsular bleeding of the spleen.

Genu valgum vs. genu varum

Genu valGUM (knock-knee): knees are GUMmed together.
· Varum (bowleg) is the other by default, or Far rhymes with Var, so knees are far apart.

Immunoglobulins -Order of appearance

'IMmunoGlobulin'
IgM appears first in response to antigens followed by IgG.

IgM antibodies appear early in the course of an infection and usually reappear, to a less extent, after further exposure. IgM antibodies cannot pass through human placenta. These two biological properties of IgM make it useful in the diagnosis of infectious diseases. Demonstrating IgM antibodies in a patient's serum indicates recent infection, or in a neonate's serum indicates intrauterine infection (e.g. congenital rubella).

Parkinson's disease: symptoms

PQRST:
Paucity of expression
parQinson
Rigidity (cogwheel)
Stooped posture
Tremor at rest
· If can't remember that Parkinson's tremor is the one that is "resting tremor", look at the last 3 letters: RST.

Renal failure (chronic): consequences

ABCDEFG:
Anemia
-due to less EPO
Bone alterations
-osteomalacia
-osteoporosis
-von Recklinghausen
Cardiopulmonary
-atherosclerosis
-CHF
-hypertension
-pericarditis
D vitamin loss
Electrolyte imbalance
-sodium loss/gain
-metabolic acidosis
-hyperkalemia
Feverous infections
-due to leukocyte abnormalities and dialysis hazards
GI disturbances
-haemorrhagic gastritis
-peptic ulcer disease
-intractable hiccups

CHARGE SYNDROME

Coloboma
Heart defects
choanal Atresia
Retarded growth
Genital hypoplasia
Ear anomalies

Types of DNS (Deviated Nasal Septum)

'SCAN your nose'

• S -shaped deformity
• C -shaped deformity
• Anterior dislocation
• Nasal spur

Deviation may involve only the cartilage,bone or both. S -shaped deformity may cause bilateral nasal obstruction.

Recurrent laryngeal nerve injury

Recurrent laryngeal nerve injury can cause 'ABCD' (besides hoarsness of voice)

Aphonia
Bronchopneumonia (due to aspiration)
Cough (ineffective)
Dysphonia

Lead poisoning: presentation

ABCDEFG:
Anemia
Basophilic stripping
Colicky pain
Diarrhea
Encephalopathy
Foot drop
Gum (lead line)

Respiratory depression inducing drugs

"STOP breathing":
Sedatives and hypnotics
Trimethoprim
Opiates
Polymyxins

Methyldopa: side effects

METHYLDOPA:
Mental retardation
Electrolyte imbalance
Tolerance
Headache/ Hepatotoxicity
psYcological upset
Lactation in female
Dry mouth
Oedema
Parkinsonism

Scrotum layers

"Some Damn Englishmen Called It The Testis":
· From superficial to deep:
Skin
Dartos
External spermatic fascia
Cremaster
Internal spermatic fascia
Tunica vaginalis
Testis

Osteomalacia: Radiological features

"Loose Penicillin Fish"

• Looser's  zone (pseudo fractures)
• Penicilling in of  vertebral bodies
• Codfish vertebrae

CHAMP

SMALL FOR GESTATIONAL AGE BABY GETS FOLLOWING PROBLEMS: [CHAMP] - REMEMBER THAT SGA BABY WILL BECOME A CHAMP.

C - CONGENITAL ANOMALIES
H - HYPOGLYCEMIA, HYPOCALCEMIA,
A - ASPHYXIA
M - MECONIUM ASPIRATION SYNDROME
P - POLCYTHEMIA, PUL. HEMORRHAGE

* Duodenal atresia vs. Pyloric stenosis: site of obstruction

Duodenal Atresia:

• Distal to Ampulla of vater.

Pyloric stenosis:

• Proximal to it.

Six “S” in Scarlet Fever

Streptococci (causative organism)
Sorethroat,
Swollen tonsils,
Strawberry tongue,
Sandpaper rash
miliarySudamina vesicles over hands, feet, abdomen

Wheezing: causes

ASTHMA:
Asthma
Small airways disease
Tropical Eosinophilia
Heart failure
Mastocytosis or carcinoid
Anaphylaxis or allergy

Ranson's criteria

  "LEGAL"

• Leucocytes >16000
• Enzyme AST >250
• Glucose >200
• Age >55
• LDH >350

 Ranson's criteria is used to predict the severity of acute pancreatitis.

Clubbing: respiratory causes

ABCDEF:
Abcess (lung)
Bronchiectasis (including CF)
Cancer (lung)
Decreased oxygen (hypoxia)
Empyema
Fibrosing alveolitis

CAUSES OF EXFOLIATIVE DERMATITIS

RED MAN
Radiation    Eczema/psoriasis    Drugs    Malignancy (MF, lymphoma)    Autoimmune (rare DM)    No cause found (Idiopathic)

Polycystic ovary: morphology, presentation

· Morphology is poly-C:
Cysts
Capsule thickened
Cortical stromal fibrosis
· Clinical presentation is OVARY:
Obese
Virilism or hirsuitism
Amenorrhoea
Reproductive disorder [infertile]
Young woman

Hypertension: secondary hypertension causes

CHAPS:
Cushing's syndrome
Hyperaldosteronism [aka Conn's syndrome]
Aorta coarctation
Phaeochromocytoma
Stenosis of renal arteries
· Note: only 5% of hypertension cases are secondary, rest are primary

Hypercalcemia: symptoms of elevated serum levels

 "Bones, Stones, Groans, Moans":
Bones: pain in bones
Stones: renal
Groans: pain
Psychic moans/ Psychological overtones: confused state

Fragile X syndrome: features

 FEMALES
FMR1 gene
Exhibits anticipation
Macro-orchidism
Autism
Long face with large jaw
Everted eyes
Second most common cause of genetic mental retardation

Causes of upper lobe fibrosis

SCAR

S- Sarcoidosis
C- Coal workers pneumoconiosis
A- Ankolysing Spondylitis
R- Radiation

Coagulation common pathway: factors in order

10 + 5 - 2 = 13
Coagulation common pathway:
Factor X to Factor V to Factor II to Factor XIII

Glycogen storage: Anderson's (IV) vs. Cori's (III) enzyme defect

 ABCD:
Anderson's=Branching enzyme.
Cori's=Debranching enzyme.
· Otherwise, can't really distinguish clinically

BUN:creatinine elevation: causes

ABCD:
Azotremia (pre-renal)
Bleeding (GI)
Catabolic status
Diet (high protein parenteral nutrition)

Niacin deficiency: signs and symptom

s The famous 4 D's:
Diarrhoea
Dermatitis
Dementia
Death (if untreated)

Folate deficiency: causes

A FOLIC DROP:
Alcoholism
Folic acid antagonists
Oral contraceptives
Low dietary intake
Infection with Giardia
Celiac sprue
Dilatin
Relative folate deficiency
Old
Pregnant

Citric acid cycle compounds

 "Oh! Can I Keep Some Succinate For Myself?":
Oxaloacetate
Citrate
Isocitrate
Ketoglutarate
Succinyl coA
Succinate
Fumarate
Malate

Hypervitaminosis A: signs and symptoms

"Increased Vitamin A makes you HARD":
Headache/ Hepatomegaly
Anorexia/ Alopecia
Really painful bones
Dry skin/ Drowsiness

Adrenaline mechanism

"ABC of Adrenaline":
Adrenaline--> activates Beta receptors--> increases Cyclic AMP

Catabolism steps of branched chain amino acids

 "Truck hit the Ox to Death":
Transamination
Oxidative decarboxylation
Dehydrogenation

Enzyme kinetics: Competitive vs. non-competitive inhibition

• With Kompetitive inhibition: Km increases(no change in Vmax. )
• With Non-kompetitive inhibition: No change in Km(Vmax decreases.)

Carbon monoxide: electron transport chain target

"CO blocks CO":
Carbon monoxide (CO) blocks Cytochrome Oxidase (CO)

Alkalosis: Metabolic changes

Think: "Al-K-loss & Al-Ca-loss"
Thus, in a state of alkalosis, there is

• loss of K⁺ causing, Hypokalemia and
• loss of Ca⁺⁺ causing Hypocalcemia

Fabry's disease

 FABRY'S:
Foam cells found in glomeruli and tubules/ Febrile episodes
Alpha galactosidase A deficiency/ Angiokeratomas
Burning pain in extremities/ BUN increased in serum/ Boys
Renal failure
YX genotype (male, X linked recessive)
Sphingolipidoses

Van den Bergh reaction (Jaundice test

) "Indirect reacting bilirubin = Unconjugated bilirubin":
Both start with vowels, so they go together: Indirect & Unconjugated.

Metabolic acidosis: causes

USED CAR:

• Ureteroenterostomy
• Saline hydration
• Endocrinopathies (hyperparathyroid, hyperthyroid, Addison's)
• Diarrhea/ DKA/ Drugs
• Carbonic anhydrase inhibitors
• Ammonium chloride
• Renal tubular acidosis

Alternatively: USED CARP, to include Parenteral nutrition/ Pancreatic fistula.

Branched chain amino acids

"LeVIs"

• Leucine
• Valine
• Isoleucine

 The combination of these three branched chain amino acids (BCAA)  makes up approximately 1/3 of skeletal muscle in the human body.
BCAAs, particularly leucine, have anabolic effects on protein metabolism by increasing the rate of protein synthesis and decreasing the rate of protein degradation in resting human muscle

Wolf Parkinson''s White Syndrome

WPW Syndrome - on ECG

Type A = QRS Above Baseline

Type B = QRS Below Baseline

Aldosterone: regulation of secretion from adrenal cortex

 RNAs
Renin-angiotensin m echanism
Na concentraton in blood
ANP (atrial natriuretic peptide)
Stress

Fluid compartments: volumes

 12345:
12 liters of interstitial fluid
3 liters plasma volume and 30 liters inside cells
45 liters total body water

Alkalosis vs. acidosis: directions of pH and HCO3

 ROME:
Respiratory= Opposite:
· pH is high, PCO2 is down (Alkalosis).
· pH is low, PCO2 is up (Acidosis).
Metabolic= Equal:
· pH is high, HCO3 is high (Alkalosis).
· pH is low, HCO3 is low (Acidosis).

Hb-oxygen dissociation curve shifts: effect, location

Left shift: causes Loading of O2 in Lungs.
Right shift: causes Release of O2 from Hb.

Gut intrinsic innervation:

 myenteric plexus vs. submucosal plexus function Myenteric: Motility.
Submucosal: Secretion and blood flow

ORDER OF EVENTS AT PUBERTY

"The Prime Minister" The - Thelarche Prime - Pubarche Minister - Menarche

Progesterone: actions

 PROGESTE:
Produce cervical mucous
Relax uterine smooth muscle
Oxycotin sensitivity down
Gonadotropin [FSH, LH] secretions down
Endometrial spiral arteries and secretions up
Sustain pregnancy
Temperature up / Tit development
Excitability of myometrium down

Compliance of lungs factors

 COMPLIANCE:
Collagen deposition (fibrosis)
Ossification of costal cartilages
Major obesity
Pulmonary venous congestion
Lung size
Increased expanding pressure
Age
No surfactant
Chest wall scarring
Emphysema
· All but L/A/E decrease compliance

Oxygen-haemoglobin dissociation curve: Causes of shift to right

CADET, face Right!

• CO2  
• Acid
• 2,3-DPG(aka 2,3-BPG)
• Exercise
• Temperature

Left shift of the Oxygen dissociation curve denotes Hemoglobin's increased affinity for oxygen (as in lungs) & right shift is a sign of decreased affinity

Muscle spindle:Origin of Primary and Secondary endings

"1 from 1, 2 from 2"

• Primary ending is from Group Ia.
• Secondary ending from Group II.

Intrinsic vs. extrinsic pathway tests

PeT  & PiTT

PeT: PT is for extrinsic pathway. 

PiTTl: PTT is for intrinsic pathway

MAO isoenzymes:Location

MAO-A in:

• Adrenergic peripheral structures
• Alimentary mucosa [intestine]

MAO-B in:

• Brain
• Blood platelets

Temperature control-Cerebral regions

"High Power Air Conditioner"

• Heating = Posterior hypothalamus.
• Anterior hypothalamus = Cooling.

Heart valves: sequence of flow

 TRIPS BIAS:
TRIcuspid
Pulmonary
Semilunar
BIcuspid
Aortic
Semilunar

Nitric Oxide Synthase (NOS) :Types

• Macrophage NOS (inducible NOS) 
• Endothelial NOS
• Neuronal NOS

Nitric oxide synthase is the enzyme facilitating synthesis of Nitric oxide(NO) from L-arginine. Functions of nitric oxide include vasodilation,reduction of platelet adhesion & aggregation and reduction of inflammatory responses.

Argyll Robertson pupil (ARP)

 " ARP "

The acronym ARP can stand for  'accomodation reflex present'.
Thus in Argyll Robertson pupil (ARP) , accomodation reflex (near reflex) is present but light reflex is absent.

Argyll Robertson pupil results from damage to relay paths in tectum between the afferent and efferent tracts. In this region, the lesion is almost invariably syphilitic.

CANCER, NINE WARNING SIGNS

C hange in blood bowel or bladder habits
Anemia (unexplained)
U nsual bleeding or discharge, Unexplained weight loss
T hickening or lump in breast or elsewhere
I ndigestion or difficulty in swallowing
O bvious change in wart or mole
N agging cough or hoarseness, No healing of sore

Prolactin and oxytocin: Functions

• PROlactin stimulates mammary glands to PROduce milk and
• Oxytocin stimulates mammary glands to OOze milk.

Tears: Composition

"Water PLUSS"

• Water

• Protein
• Lysozyme
• Urea
• Salts and
• Sugar

Heart: -tropic definitions

Lusitropic: loose is relaxed. Definition: relax heart.
Inotropic: when heart wall contracts, moves inward. Definition: contract heart.
Chronotropic: 'chrono-' means 'time'. Defintion: heart rate (of SA node impulses).
Dromotropic: only one left, it must be conduction speed by default.

PGI2 vs. TxA2 coagulation function

TxA2 Aggregates platelets.
PGI2 Inhibits aggregation.
· Note: full name of PGI2 is prostaglandin I2 or prostacyclin, full name of TxA2 is thromboxane A2.

Sensations conducted via Lateral spinothalamic tract

" Pa.Te.La "
Read as "Patella"

Pain & Temperature are conducted through the Lateral spinothalamic tract.

Transferrin: Normal levels

For remembering  normal level of transferrin,
think: " Trans-Ferrin "

• The normal level of transferrin in blood is 2-5g/L (Two-Five)

Now, for remembering normal range of Transferrin saturation,
think: " Transferrin Saturation "

• The normal transferrin saturation is 20-60% (Twenty- Sixty).

The value is 25-56% to be more accurate.

Adrenal cortex layers

G(lomerular)-Glomerulosa
F(iltration)-fasciculata
R(ate)-Reticularis

Carotid sinus and Carotid body: Functions

• Carotid SinuS measures: preSSure
• Carotid bOdy measures : Oxygen

Pituitary hormones FLAGTOP:

Follicle stimulating hormone
Lutinizing hormone
Adrenocorticotropin hormone
Growth hormone
Thyroid stimulating hormone
Oxytocin
Prolactin
Alternatively: GOAT FLAP with the second 'A' for Anti-diruetic homone/vasopressin
· Note: there is also melanocyte secreting homone and Lipotropin, but they are not well understood.

Deep venous thrombosis: genetic causes

ALASCA:
Antithrombin III
Leiden (Factor V)
APC (Activated Protein C)
S-protein deficiency
C-protein deficiency
Antiphospholipid antibody

5 P's of Septic Abortion

5 P's of Septic Abortion ( clinical features)
P- Pyrexia
P- Pain in abdomen
P- Pulse rate increase: 100-200/min
P- Purulent vaginal discharge
P- Pelvic findings: Patulous os or a boggy feel of the uterus

cerebellar signs

DANISH

Dysdiadokokinesia, Dysmetria
Ataxia towards the side of lesion
Nystagmus
Intention tremor
Slurred speeech
Hypotonia

Fetal alcohol syndrome (FAS): Features

"FAS"

• Facial hypoplasia, Forebrain malformations
• Attention deficit disorder (ADD), Altered joints
• Short stature, Septal defects, Small(low) IQ

THICKENED NERVES--CAUSES

LANDS

Leprosy
Amyloiodosis
Neurofibromatosis
Diabetes
Sarcoidosis

SYNDROME X

H3O

HYPERTENSION
HYPERINSULINAEMIA
HYPERLIPIDEMIA
OBESITY.

Gynecomastia: common causes

GYNECOMASTIA:

Genetic Gender disorder (Klinefelter)
Young boy (pubertal)*
Neonate*
Estrogen
Cirrhosis/ Cimetidine/ Ca Channel blockers
Old age*
Marijuana
Alcoholism
Spironolactone
Tumors (Testicular & adrenal)
Isoniazid/ Inhibition of testosterone
Antineoplastics (Alkylating Agents)/ Antifungal(ketoconazole)
· * Asterisk indicates physiologic cause.

Acute ischemia: signs [especially limbs]

6 P's:
Pain
Pallor
Pulselessness
Paralysis
Paraesthesia
Perishingly cold

McArdle's syndrome

MCARDLES:
Myoglobinuria
Cramping after exercise
Accumulated glycogen
Recessive inheritance
Deficiency of muscle phosphorylase
Lactate levels fail to rise
Elevated creatine kinase
Skeletal muscle only

Sarcomas with lymphatic metastasis

Sarcomas in which Lymphatic Metastasis is seen -
can be remembered by the mnemonic RACE For MS

R: Rhabdomyosarcoma
A: Angiosarcoma
C: Clear cell sarcoma
E: Epithelial cell sarcoma

For: Fibrosarcoma

M: Malignant fibrous histiocytoma
S: Synovial cell sarcoma

Diaphragm apertures: Spinal levels

"AEI-OU"

Aorta: T12
Esophagus: T10
Inferior Vene cava: T8
OU can be used to remember  that its On moving Up from T12.



Or,

"Voice Of America"
In order, from lower to higher vertebral levels,

Causes for Post-operative fever

Six W's:
Wind: pulmonary system is primary source of fever first 48 hours, may have pneumonia
Wound: infection at surgical site
Water: check IV for phlebitis
Walk: deep venous thrombosis, due to pelvic pooling or restricted mobility related to pain and fatigue
Whiz: urinary tract infection if urinary catheterization
Wonder drugs: drug-induced fever

CHEDIAK-HIGASHI SYNDROME

	HIGASHI
Hair, silver    Immune Deficiency    orGanelle-Lysosome    Anemia, thrombocytopenia, leukopenia    Seizures, CNS    pHotophobia    Inclusions-giant, azure

Indications for an Upright X-ray

 A PURE upright x-ray

  A:Appendicites
  P:Penetrating trauma
  U:Ulcer disease
  R:Ruptured diverticulum
  E:Endoscopy (iatrogenic)

Honeycomb Lung

BIG SHIP

Bleomycin
Idiopathic
Granulomas 
Sarcoid
Histiocytosis X
Interstitial pneumonia
Pneumoconiosis

Hair- on- end appearance

HITS Enzyme

Hereditary spherocytosis
Iron defeciency anemia
Thalassemia Major
Sickle cell disease
Enzyme defeciency - G6PD

Tumors that metastasize to skin

BLOCK:
Breast
Lung
Ovary
Colon
Kidney

Lung cancer: notorious consequences SPEECH:

Superior vena cava syndrome
Paralysis of diaphragm (Phrenic nerve)
Ectopic hormones
Eaton-Lambert syndrome
Clubbing
Horner syndrome/ Hoarseness

Apical Fibrosis

THE SCARS

TB
Histoplasmosis
Extrinsic Allergic Alveolitis
Silicosis
Coal Worker's Pneumoconiosis
Ankylosing Spondylitis
Radiotherapy
Sarcoidosis

Osteoarthritis: x-ray signs LOSS:

Loss of joint space
Osteopyhtes
Subcondral sclerosis
Subchondral cysts

Lung cancer: main sites for distant metastases BLAB:

Bone
Liver
Adrenals
Brain

Prognotic factors for cancer: general PROGNOSIS:

Presentation (time & course)
Response to treatment
Old (bad prog.)
Good intervention (i.e. early)
Non-compliance with treatment
Order of differentiation (>1 cell type)
Stage of disease
Ill health
Spread (diffuse)

Esophageal cancer: risk factors ABCDEF:

Achalasia
Barret's esophagus
Corrosive esophagitis
Diverticuliis
Esophageal web
Familial

Neck sagittal x-ray: examination checklist ABCD:

Anterior: look for swelling
Bones: examine each bone for fractures
Cartilage: look for slipped discs
Dark spots: ensure not abnormally big, or could mean excess blood

Mass in anterior mediastinum: Causes

"4 T's"

• Thyroid enlargement (Retrosternal extension)
• Thymoma
• Teratoma
• "Terrible" Lymphoma